Kuis Daan Jan, van de Giessen Tara, de Jong Steven, Sportel Bouwina Esther, Boonstra Nynke, van Donkersgoed Rozanne, Lysaker Paul H, Hasson-Ohayon Ilanit, Pijnenborg Gerdina Hendrika Maria
Geestelijke Gezondheidszorg (GGZ) Drenthe Mental Health Institute, Department of Psychotic Disorders, GGZ Drenthe, Assen, Netherlands.
Lentis Research, Lentis Psychiatric Institute, Groningen, Netherlands.
Front Psychiatry. 2021 Nov 11;12:730092. doi: 10.3389/fpsyt.2021.730092. eCollection 2021.
Social functioning is often impaired in the ultra-high-risk (UHR) phase of psychosis. There is some evidence that empathy is also impaired in this phase and that these impairments may underlie difficulties in social functioning. The main aim of this study was to investigate whether cognitive and affective empathy are lower in people in the UHR phase of psychosis in comparison to healthy controls, and whether possible impairments have the same magnitude as in people with schizophrenia. A second aim was to examine whether there is a relationship between empathy and social functioning in individuals in the UHR phase. Forty-three individuals at UHR for psychosis, 92 people with a schizophrenia spectrum disorder, and 49 persons without a psychiatric disorder completed the Interpersonal Reactivity Index (IRI), Questionnaire of Cognitive and Affective Empathy (QCAE), and Faux Pas as instruments to measure empathy. The Time Use survey was used to measure social functioning. MAN(C)OVA was used to analyse differences between groups on empathy and social functioning, and correlations were calculated between empathy measures and social functioning for each group. The UHR group presented significantly lower levels of self-reported cognitive empathy than the healthy controls, but not compared to patients with SSD, while performance-based cognitive empathy was unimpaired in the UHR group. On the affective measures, we found that people with UHR and patients with SSD had significantly higher levels of self-reported distress in interpersonal settings compared to healthy controls. In the UHR group, perspective-taking was negatively associated with time spent on structured social activities. In the SSD group, we found that structured social activities were positively associated with perspective-taking and negatively associated with personal distress in interactions with others. Lastly, in people without mental illness, social activities were positively associated with performance-based perspective-taking. Impairments in subjective cognitive empathy appear to be present in the UHR phase, suggesting that difficulties in interpreting the thoughts and feelings of others precede the onset of psychotic disorders. This can inform future interventions in the UHR phase.
在精神病的超高风险（UHR）阶段，社会功能常常受损。有证据表明，在此阶段共情能力也会受损，且这些损伤可能是社会功能障碍的潜在原因。本研究的主要目的是调查与健康对照组相比，处于精神病UHR阶段的人其认知共情和情感共情是否较低，以及可能存在的损伤程度是否与精神分裂症患者相同。第二个目的是检验处于UHR阶段的个体中，共情与社会功能之间是否存在关联。43名处于精神病UHR阶段的个体、92名患有精神分裂症谱系障碍的人以及49名无精神疾病的人完成了人际反应指数（IRI）、认知与情感共情问卷（QCAE）以及失言检测，以此作为测量共情的工具。使用时间利用调查来测量社会功能。采用多变量协方差分析（MAN(C)OVA）来分析各组在共情和社会功能方面的差异，并计算每组共情测量指标与社会功能之间的相关性。UHR组自我报告的认知共情水平显著低于健康对照组，但与精神分裂症谱系障碍患者相比无差异，而UHR组基于表现的认知共情未受损。在情感测量方面，我们发现与健康对照组相比，处于UHR阶段的人和精神分裂症谱系障碍患者在人际环境中自我报告的痛苦程度显著更高。在UHR组中，换位思考与花在有组织社会活动上的时间呈负相关。在精神分裂症谱系障碍组中，我们发现有组织的社会活动与换位思考呈正相关，与与他人互动时的个人痛苦呈负相关。最后，在无精神疾病的人群中，社会活动与基于表现的换位思考呈正相关。主观认知共情的损伤似乎在UHR阶段就已存在，这表明在精神障碍发作之前就存在理解他人想法和感受的困难。这可为UHR阶段未来的干预措施提供参考。
